Surely one of the most gratifying aspects of being a dental practice owner is the payment one receives for all of the years of hard work and dedication put forth throughout dental school, residency, and the humble beginnings of private practice. After all, from those on the outside looking in, an individual who owns their own business is the luckiest person alive!
Well, once you have been snapped back into the cold hard reality of life, you start to realize that owning your own business is far from being blissful. In actuality it takes a tremendous effort at times just to keep it afloat. But what about the issue of getting paid? It sounds easy enough, doesn't it? You provide a service, you should get paid for it. No problem, right? After all, it works in theory. But for the veterans out there who have been through the school of hard knocks, providing the service, and actually getting paid for it, can be two entirely different matters.
As a practice-management consultant this is by far one of our most frustrating obstacles in dentistry. But let's suspend reality for just a moment and imagine that dental insurance is no longer a factor. No decision to make regarding whether to go fee for service or delve deeper into insurances. Now don't get me wrong there are applications in the real world of dentistry that support insurance and vice versa, but for arguments sake, let's go with this hypothetical scenario. Patients would simply do what is asked of them, follow through with the treatment recommended because they want to, and never question the financial aspects of the care you provide. Sounds great, but for those of us in the trenches of dentistry, we live in reality, not picture book fantasy.
Many have the illusion that dental practices who have jumped the hurdle to fee for service, insurance free have it made. Think again. They still have a tendency to do battle over getting paid for services. Doing good dentistry and getting paid for it is a challenge regardless of insurance. Patient perception, and more importantly, resistance plays a critical role in the financials of it all.
Some believe that elimination of insurance from our industry is the answer, simply all go fee for service, others believe that diving deeper into DMOs will finally provide our salvation. But reality of the matter is that we, the dental professionals created the situation of NOT getting paid for our services. If one of our patients walks into a beauty salon for hair color, cut, and manicure, do they go with the intention of NOT paying for these services, NO! When we take our kids to the pediatrician, do we go unprepared to pay our bill, NO! So, why on earth do our patients assume that it's okay to come in, get the necessary dental work completed, and shout, "bill me" as they scoot out the door? They do so because we have created the environment and allowed it to occur for so long, it is now a difficult uphill battle to get them to change, conform to our policy of payment upon services rendered. It started very innocently with a patient who "forgot" their wallet, or a patient who had fallen under hard times and just needed a break, to now a collections nightmare of 60 percent!
How do we get patients to finally turn around? Well, if you are a participating Practice, you are obligated to accept what the insurance plan covers and in this instance, you are not going to get paid at the time of services. If you happen to merely accept insurance, generally the rule of thumb is to allow the insurance to pay you first, and the patient is then subsequently billed for any remaining balance, again, not getting paid at the time of services. But if you have removed yourself from the insurance issue altogether, believe it or not, you may have put yourself in a rather precarious situation of having far less success in reaping what is owed than the other two examples of practices in this country. Surprised? You shouldn't be. When you are dealing with an insurance company, yes, they can be a real pain, and yes they do sometimes tie the hands of the dental professional and limit patient options, but the practices are recouping more than you may think. Now before you think all is lost and you are better off going the insurance route, keep in mind, insurance is not the end all, be all, and neither is FFS. You have to do a little investigating, find out what will work in your particular location, where do the majority of your patients work, and what type of patients are you trying to attract to your practice. These are critical in your decision making process and even more so in getting paid for your services.
But if you have made up your mind that FFS, hands down is the answer to your problems, there are several different options available to you regarding payment, one that has had incredible success is a Credit Card Retainer System. Under this new policy, each patient would supply you with a credit card that you would keep on file in your database. On the day of their appointment, the patient either brings an alternative method of payment or the credit card, which has already been authorized for this purpose, is charged. It works beautifully. The tricky part of this or any newly implemented policy is your existing patient base and their ever-growing resistance to pay you. But make it policy and there is little room for negotiation. New patients are very seldom a problem. They are coming to your practice without any preconceived notions of what to expect in relationship to policy. When they make their appointment, the CCRS is automatically implemented similar to that of a hotel reservation. In fact, you cannot travel, make hotel reservations, without first providing a credit card to reserve your space. This is as basic of a concept as it gets. If you make a reservation and do not cancel within their indicated time, what happens? Your credit card is automatically charged. Talk about finally having a solution to broken appointment 'wanna-bes'!
Tired of reserving a two hour time slot for a Crown Prep, only to have the patient not show up? Well, Patients who repetitively reek havoc on your schedule in this manner are subject to not only the CCRS, but an added stipulation that their credit card must be charged in order to even get another appointment in your practice. The patient then has a vested interest in that non-refundable future appointment, and they will show up! By providing you with their credit card information, the patient is giving informed consent to the policy. If they do not agree to the policy they simply do not supply the information. Most patients are more than willing to do this as at least a backup form of payment. If they do not have a credit card or they fail the credit check of other alternative payment options such as Care Credit, red flags are indicated.
One of the main issues that I hear frequently is that Dentists feel guilty or bad for asking to be paid for their services. You are providing high quality dentistry, prevention and treatment of disease, and a service that requires payment in order to continue. There is no shame in demanding payment for your hard work, effort, and premier customer service. Keep in mind, once the crown is cemented short of resorting to the use of a jackhammer, you cannot repossess the goods. As a business owner you have the right to look after your best interest and your bottom line. Implementing a CCRS or any payment at the time of service alternative does not guarantee payment unless the practice owner assumes a leadership role and delegates the appropriate policy. While being flexible will get you a "Nice Guy Of The Year" Award, it's not going to cover your growing overhead costs of running a dental practice. Remember, the high quality premier services you provide, coupled with the fact that the patient is walking away with a beautiful, healthy smile -- it's a win-win situation, but only if you get paid!
AUTHOR INFORMATION
Tammy Carullo owns and operates Practice by Design Consulting, Inc., bringing 18 years in both dentistry and business administration providing a unique philosophy to resolving dental practice issues, creating wealth, stability, and security for your future.
Tammy L. Carullo PC PS CEO
www.practicebydesign.com
Practice by Design Consulting, Inc.
8 Chris Lane
Lebanon, PA 17042
Phone 717-867-5325
E-mail [email protected]
